nc department of health and human services division of health service regulation mental health...

NC Department of Health and Human Services

Division of Health Service Regulation

http://www.ncdhhs.gov/dhsrMental Health Licensure & Certification Section

New Provider Orientation

Division of Health Service RegulationMental Health Licensure & Certification

Section




ObjectivesUpon completion of this training, each participant will:• Comprehend the knowledge and skills required to

be a successful mental health provider• Become familiar with the General Statutes and

numerous rules and regulations required for licensure

• Understand the role of DHSR, DMH/DD/SAS, DMA and the LME/MCO

• Identify the steps in the initial licensure process




Getting Started

The process starts when you:•Contact us•Visit our website •Understand the importance

and legal aspects of having a mental health license




Knowledge RequiredA mental health provider must have knowledge and be

proficient in a variety of areas. Some include:• Assessment & Treatment Planning• Client Rights & Confidentiality• CPR & First Aid• The Population Served• Cultural Awareness• Medications• Restrictive Interventions




Skills RequiredA mental health provider must have skills in a variety

of areas. Some include:• Interpersonal Skills• Communication Skills• Decision Making• Clinical Expertise• Critical Thinking• Problem solving• Collaboration




Statute, Rule, Policy & Procedure




North Carolina General Statute 122C

• General Statutes are laws passed by the NC General Assembly and signed by the Governor. These laws:• Outline the basic requirements for licensure• Define what constitutes a mental health licensable facility• Designate client rights available to all people served• Include requirement not set forth in rule such as

information about penalties and sanctions

• The Department of Health and Human Services creates rules from General Statutes to provide guidance on how to meet the requirements of the law




Rules and RegulationsThe following rules are essential for all licensed mental health

facilities to help formulate the required Operations and Management Policies, Guidelines and Procedures:

• 10A NCAC Chapter 26 Mental Health, General • Subchapter C: Other General Rules

• 10A NCAC Chapter 27 Mental Health, Community Facilities and Services• Subchapter C: Procedures and General Information• Subchapter D: General Rights• Subchapter E: Treatment or Habilitation Rights• Subchapter F: 24-Hour Facilities• Subchapter G: Rules for Mental Health, Developmental Disabilities,

and Substance Abuse Facilities and Services• Rules can be obtained online at:

http://www.ncdhhs.gov/dhsr/mhlcs/rules.html




Core Licensure RulesEvery licensed facilities must adhere to all core rules in

27G .0100 - .0905• Core rules include, but are not limited to:

• General & staff definitions• Governing body policy requirements• Client record requirements• Staff record & training requirements• Client services & treatment plan requirements• Emergency plan requirements• Medication requirements• Physical plant requirements• Licensing requirements• Incident reporting requirements




Program Specific Licensure Rules

In addition to core rules, facilities must also adhere to the program specific rules for the licensed service category.

• Program specific rules are within 10A NCAC Chapter 27G .1000 - .7101

• Providers must know the service they are licensed to provide and ensure they adhere to the correct program specific rules

• For example: a provider licensed to provide residential services to adults with mental illness would be licensed as a “5600A”• In addition to the core rules, the provider must also adhere to

rules 27G .5601 - .5604




Client Rights RulesIn addition to core and program specific rules, facilities

must adhere to all client rights rules.• Client rights rules are within 10A NCAC Chapter 27

• Subchapter C: Procedures and General Information• Subchapter D: General Rights• Subchapter E: Treatment or Habilitation Rights• Subchapter F: 24-Hour Facilities

◦ These client rights rules only apply to facilities licensed to provide residential services

• Client rights rules cannot be waived




Policy and Procedure•Policies are the business rules under which an agency will operate. They ensure consistency and compliance with state rule and statute.•Policies are the guidelines under which procedures are developed.•Policies and procedures should be written clearly enough that your newest least skilled staff person knows what to do just by reading it.




NCAC 27G .0400 – Licensing Procedures

Section 27G .0400 of the North Carolina Administrative Code sets forth the requirements for mental health licensure.

• Rules in this section include, but are not limited to:• The requirement that DHSR conducts inspections without

advance notice (27G .0404(f))• The requirement for annual surveys for residential facilities

(27G .0404(h))• The requirement that providers notify DHSR in writing 30 days

prior to an increase/decrease in capacity, change of program service, change of location and/or construction of a new facility or renovations to an existing facility (27G .0404(i))




Staffing RulesThere are a variety of staffing rules. The provider is

ultimately responsible for all actions of his/her staff.• Core Staffing Rules Include, but are not limited to:

• Staff definitions• educational requirements• training requirements• competency & supervision requirements

• Program Specific Staffing Rules Include, but are not limited to:• Staffing pattern requirements for the licensed service

• Fundamental Staff Member for all Licensed Programs• Qualified Professional




Qualified ProfessionalsA Qualified Professional (QP) has a combination of

education and experience working with a population.

• North Carolina Administrative Code (NCAC) 27G .0103(19) defines the specific experience and educational requirements to be classified a qualified professional.

• NCAC 27G .0203 outlines the requirements for the competencies of qualified professionals.




Hiring a Qualified ProfessionalWhen determining who to hire as a qualified

professional, consider the following:• The type of clients you will be serving• The service you will be providing to the clients• The experience of the qualified professional

• type of clients he/she has worked with• type of service he/she has provided




Qualified Professional’s Responsibility

You should expect your qualified professional to:• Present training for you and your staff• Provide clinical oversight of your clients• Provide supervision for you and your staff• Participate in assessment and treatment planning

for your clients




1915(b)/(c) Medicaid Waiver• Legislation passed in 2011 requires the North Carolina

Department of Health and Human Services to restructure the management responsibilities for the delivery of services to individuals with mental illness, intellectual and developmental disabilities and substance abuse disorders through the 1915(b/c) waiver.

• The MH/DD/SA services for Medicaid recipients and the uninsured in North Carolina will be managed by 11 Local Management Entities (LMEs) that will function as managed Care Organizations (MCOs)

• Implementation was staged in tiers which began October 2011. The last set of LME/MCOs plan to begin operation in January 2013. State law requires the transition for the entire state to the 1915(b/c) Medication Waiver by July 1, 2013.




LME/MCOThe Local Management Entity (LME)/ Managed Care

Organization (MCO) is an important partner for providers of mental health services. The LME/MCO:

• Serves people in their geographic area who need mental health or substance abuse services.

• Contracts only with providers who have a mental health license (if the service requires licensure)

• Often a referral source for clients




LME/MCOThe 1915 (b)/(c) Medicaid waiver and creation of the

MCOs will change the way providers are paid for services. Some of the most significant changes for providers include:

• Providers will enroll and bill for Medicaid services with the LME/MCO, not the Division of Medical Assistance (DMA)

• The LME/MCO will authorize services for clients in their geographical region

• The LME/MCO will pay the provider for services for clients in their geographical region

• Providers may have to contract with multiple LME/MCOs in order to get paid for services




LME/MCOLME/MCO involvement is essential for residential

facilities.• All residential facilities must obtain a letter of support

from the LME/MCO prior to submitting a initial licensure application to DHSR.

• A letter of support can only come from the LME/MCO serving the geographical area in which the home is to be located. It states there is a need for the residential service in the geographical area served by LME/MCO.

• A residential application brought to DHSR without a letter of support will not be processed and will be immediately returned to the applicant.




LME/MCO Map (as of 10/1/2013)




LME/MCOFor more information regarding LME/MCOs and the

1915(b)/(c) Medicaid waiver, visit the web pages below: • Division of Mental Health/Developmental Disabilities/

Substance Abuse Services (DMH/DD/SAS)• http://www.ncdhhs.gov/mhddsas/

• DMH/DD/SAS LME/MCO Contact Information• http://www.ncdhhs.gov/mhddsas/lmeonbluebyname.htm• http://www.ncdhhs.gov/mhddsas/lmeonblue.htm

• DMH/DD/SAS 1915(b)/(c) • http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/

index.htm




North Carolina Mental Health System




Compliance vs. Non-compliance• DHSR/MHL&C staff conduct annual surveys and

complaint investigations to ensure facilities are in compliance with the licensure rules.

• Evidence of failure to meet the requirements outlined in rule are evaluated for scope and severity.

• Citations are issued as standard deficiencies or as violations.

• Survey results are documented in a statement of deficiencies which is sent to the licensed provider after a survey or investigation.




G.S. 122c-24.1 – Penalties; Remedies

• “The Department of Health and Human Services shall impose an administrative penalty in accordance with provisions of this Article on any facility licensed under this Article which is found to be in violation of Article 2 or 3 of this Chapter or applicable State and federal laws and regulations…”

• Initial penalties range from $500.00 – $20,000.00• Ongoing penalties range from $200.00 - $1,000.00 per

day• For more information about Penalties and GS 122C visit

the following web page:• http://www.ncleg.net/gascripts/Statutes/StatutesTOC.pl?Chapter=0122C




Violations• Type A1: “…violation by a facility…which results in death

or serious physical harm, abuse, neglect, or exploitation.”• Type A2: “…violation by a facility…which results in

substantial risk that death or serious physical harm, abuse, neglect, or exploitation will occur.”

• Past Corrected Type A1 or Type A2: “…either (i) the violation was not previously identified by the Department or its authorized representative or (ii) the violation was discovered by the facility and was self-reported, but in either case the violation has been corrected…”

• Type B: “…violation by a facility…which is detrimental to the health, safety or welfare of any client…”




Initial Licensure Process• Applicant completes the application• If residential facility: applicant obtains letter of

support from LME/MCO• Applicant submits completed application package

to DHSR Mental Health Licensure & Certification (MHLC) Section.

• If residential facility: MHLC Section forwards applications to Construction

• If residential facility: DHSR Construction Section conducts physical plant inspection




Initial Licensure Process (continued)

• If residential facility: DHSR Construction Section forwards application to the Mental Health Licensure Section.

• DHSR Mental Health Licensure Consultant conducts in-office review of facility policies, procedures, training curriculums, personnel & client records• Client record is a “mock” record

• DHSR Mental Health Licensure Consultant conducts an on-site survey

• When it is determined the provider demonstrates competency and compliance with all licensure rules, a mental health license is issued.• Providers can only admit clients after the license has been

issued.




Licensure Fees – Initial LicenseThe initial license fee structure was revised 10/1/2005. G.S. 122C-23

prohibits the issuance of a license until the fee is paid in full.

Type of Facility Number of Beds Base Fee Per Bed Fee

Non-ICF/IID Facilities 6 or less $350.00 $0

Non-ICF/IID Facilities 7 or more $525.00 $19.00

ICF/IID Facilities 6 or less $900.00 $0

ICF/IID Facilities 7 or more $850.00 $19.00

Non Residential Facilities

N/A $265.00 N/A




Construction Initial License FeesA one time per project fee to review physical plant requirements will be assessed for all initial licenses. The DHSR construction section will bill

providers prior to the on-site visit.

Type of Facility Number of Beds Project Fee

Non-ICF/IID Facilities 1-3 $125.00



ICF/IID Facilities 1-6 $350.00

Other Residential Facilities

10 or more$275.00 + $.15/sq.ft.

project space




Licensure Fees – Annual Renewal

Licenses must be renewed by the 31st of each year. An annual fee is assessed for renewal. G.S. 122C-23 prohibits the issuance of a license until the fee is

paid in full.

Type of Facility Number of Beds Base Fee Per Bed Fee

Non-ICF/IID Facilities 6 or less $305.00 $0

Non-ICF/IID Facilities 7 or more $475.00 $17.50

ICF/IID Facilities 6 or less $845.00 $0

ICF/IID Facilities 7 or more $800.00 $17.50

Non Residential Facilities

N/A $215.00 N/A




Licensure ApplicationsIncomplete applications will be immediately returned

and will delay your licensure process. In order to be accepted, applications must be:

• Accurate• Complete• Accompanied by zoning and building inspections• Accompanied by accurate licensure fees• Signed




You are ResponsibleThe initial licensure process typically takes approximately

2 – 3 months but could take significantly longer, depending on you.

You are responsible for:• Ensuring your policies & procedures are accurate• Ensuring your client & staff records are accurate• Ensuring your zoning & building inspections are accurate• Ensuring your facility is clean, furnished and ready to

accept clients• Ensuring you demonstrate competency and compliance

with all licensure rules




Contact Information Division of Health Service Regulation

Mental Health Licensure & Certification Section2718 Mail Service CenterRaleigh, NC 27699-2718

Initial SurveyorsNatalie Haith-Edwards

Arlean BrooksJoy Allison

http://www.ncdhhs.gov/dhsr/mhlcs/mhstaff.html




AlamanceAlexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Camden

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Currituck

DareDavidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery

Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

Yancey

NC Division of Health Service RegulationMental Health Licensure & Certification Section

Initial Surveyor Territories




Final RemindersHolding a mental health license means:• You are responsible for everything that happens in

the facility• Monetary penalties and sanctions can be assessed

against you• DHSR will inspect your facility, unannounced, at any

time of day• You can make a difference in the life of a person in

need of services

nc department of health and human services division of health service regulation mental health...

Documents

nc department of health

mental health license

services rules

general rules

governor licensure rules

mental illness

core rules

following rules